What does neglect look like

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What does neglect look like?

• Allan Funk
• Occupational Therapist
• Foothills Medical Centre

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glect look like?

• Funk
• al Therapist
• dical Centre

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What does neglect look like?

• Allan Funk
• Occupational Therapist
• Foothills Medical Centre

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at es lect ok ke?

• an nk
• tional apist
• hills ical tre

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Not so neglected

• Hot topic
• Implications for safety, independence are varied
  and serious
• Many subtypes
• Limited understanding many limitations in
  assessment and treatment

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Impact

• Mobility
• Driving
• ADL
• IADL

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Neglect

• How does it work?
• How does it break down?

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• What process or mechanism is breaking down?
• Registration, integration, selection, action
• Sensation, perception, cognition, praxis

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Sensation

• Peripheral or central
• Attention

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Integration

• Coordinate systems eye-centered, head-centered,
  body-centered, gravitational
• Perceptual fields relative leftness,
  environment vs. object
• Peri-personal vs. extra-personal
• Construction

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Selection

• Attention
• Stimuli number, structure, contrast, salience,
  novelty, speed
• Recognition
• Vigilance Useful field of view
• Central executive

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Action

• Visual or manual search
• Mobility
• Writing

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Subtypes

• Right vs. left
• Incidence

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Subtypes

• Sensory- perceptual mode
• Kinaesthetic
• Auditory
• Visual spatial
• Reading

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Subtypes

• Useful field of view

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Subtypes

• Extinction

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Fellow travellers

• Awareness - anosognosia
• Indifference - anosodiaphoria
• Sensory loss
• Attention
• Memory
• Motor impairment

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Anatomy

• inferior parietal, frontal lobe, cingulate
  cortex, superior colliculus, lateral hypothalamus
  
• anterior (lesion limited to the prefrontal cortex
  and adjacent white matter) posterior (lesion
  limited to the retrorolandic cortex, including
  parietal, but also temporal and/or occipital
  regions) anteroposterior (lesion involving both
  prefrontal, rolandic, and posterior regions,)
  subcortical (lesion limited to subcortical areas,
  such as internal capsule, centrum semiovale,
  striatum, or thalamus)
• Occipital lobe, anterior limb of the internal
  capsule, posterior limb of the internal capsule,
  anterior portion of paraventricular white matter,
  posterior portion of paraventricular white
  matter, thalamus

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Anatomy II

• Top-down
• Bottom-up
• Posterior parietal cortex, frontal eye fields,
  cingulate gyrus
• Thalamus, striatum, superior colliculus,
  ascending reticular activating system

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Assessment

• Pencil and paper or computer-based tasks
• Scoring
• Sensitivity

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Assessment

• Cancellation
• Bisection
• Visual scanning
• Construction
• Reading

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Assessment

• Cancellation visual search pattern is most
  predictive
• Right start gtdistribution of errorsgtnumber of
  errors
• Bisection placement and length

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Assessment

• Preponderance of pencil paper
• There is not yet a reliable, sensitive formal
  test of extra-personal neglect.

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Function

• Much better sensitivity than pencil and paper
• Complexity of enivronment is key
• interpretation requires knowledge of subtypes

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Treatment

• Focus on where the process is breaking down

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Treatment

• Sensation use attention to compensate
• Use soundbites or acronyms to facilitate
  acquisition of compensatory strategy
• Minimum cueing fading ensure the patient is
  as active as possible in generating the desired
  behaviour
• Target key functional tasks where safety is a
  particular concern here you may need to cue
  more heavily

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Treatment

• Integration poorly understood.
• Eliminate distractions, try to use the simplest
  successful tasks/materials/environments.

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Treatment

• Selection/Attention treatment may not
  generalise from one sensory-perceptual mode to
  another
• Amenable to remediation
• Delineate relevant subtypes
• Manipulate key stimulus variables to grade and
  progress tasks number, novelty, structure,
  salience, speed, contrast

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Treatment

• Action